Provider Demographics
NPI:1649419433
Name:LOPORTO, JAMES BENJAMIN (COTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BENJAMIN
Last Name:LOPORTO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 EDWARDS DR
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-6215
Mailing Address - Country:US
Mailing Address - Phone:845-744-3930
Mailing Address - Fax:
Practice Address - Street 1:22 EDWARDS DR
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-6215
Practice Address - Country:US
Practice Address - Phone:845-744-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004068-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker